Tenosynovitis (plural: tenosynovitides - rarely used) is a term describing the inflammation of the synovial membrane surrounding a tendon and may be seen with or without tendinosis/tendinitis. The synovial membrane is part of a fluid-filled sheath that surrounds a tendon.
- joint swelling
- pain in the affected area and pain moving a joint
- reddening along the length of the affected tendon
- difficulty moving the joint
Tenosynovitis can be caused by a variety of disease processes, including, but not limited to:
- mechanical irritation
- rheumatoid arthritis: most common to involve extensor carpi ulnaris and flexor carpi radialis
- compartment syndrome
- stenosing tenosynovitis:
Plain radiographs are non-diagnostic but may show calcification of one or several synovial membranes (this finding orients towards rheumatism for hydroxyapatite or a condrocalcinosis) and a periosteal reaction in an adjacent bone.
The synovial membrane is not identified unless there is a pathological swelling. Tenosynovitis is characterized by increased fluid content within tendon sheath, thickening of the synovial sheath with or without increased vascularity which can extend into the tendon sheath, and peritendinous subcutaneous edema. Subcutaneous edema can result in a hypoechoic halo sign and peritendinous subcutaneous hyperemia on Doppler imaging.
Color Doppler ultrasound is an important part of the tendon sheath assessment; it can differentiate between synovial thickening which is more suggestive of chronic disease and turbid tendon sheath fluid collection- more indicative of acute exudative tenosynovitis. In chronic inactive disease, however, there is synovial thickening with minimal vascularity.
Increased fluid within tendon sheath:
- T1: low or intermediate if debris within tendon sheath
- T2: high
- T1 C+ (Gd): tendon sheath thickening and peritendinous subcutaneous contrast enhancement
Treatment and prognosis
Treatments may include non-steroidal anti-inflammatory drugs, bandage or splint, cold therapy, and/or rest. Surgical procedures to release the tendon are very rarely suggested. If there is no infection present, and the tenosynovitis persists after a period of rest, then a steroid injection may be suggested. If the tenosynovitis was caused by infection then a course of antibiotics will likely be offered. Physiotherapy is an option.
If the tendon communicates with a joint, such as the long head of biceps at the shoulder, and flexor hallucis longus at the ankle, then no fluid should be present in the joint to make the call.
- 1. Kijowski R, Smet A, Mukharjee R. Magnetic resonance imaging findings in patients with peroneal tendinopathy and peroneal tenosynovitis. Skeletal Radiol. 2006;36 (2): 105-114. Skeletal Radiol (full text) - doi:10.1007/s00256-006-0172-7
- 2. Conde Melgar MJ et al. Afecciones inflamatorias de los tendones y de sus vainas sinoviales. Medynet. 2012. Manual de urgencias y emergencias (visited 05, february, 2013). (full text)
- 3. Jeffrey RB, Laing FC, Schechter WP et-al. Acute suppurative tenosynovitis of the hand: diagnosis with US. Radiology. 1987;162 (3): 741-2. Radiology (abstract) - Pubmed citation
- 4. Anderson SE, Steinbach LS, Stauffer E et-al. MRI for differentiating ganglion and synovitis in the chronic painful wrist. AJR Am J Roentgenol. 2006;186 (3): 812-8. AJR Am J Roentgenol (full text) - doi:10.2214/AJR.04.1879 - Pubmed citation
- 5. Fredberg U. Tendinopathy--tendinitis or tendinosis? The question is still open. (2004) Scandinavian journal of medicine & science in sports. 14 (4): 270-2. doi:10.1111/j.1600-0838.2004.404_3.x - Pubmed